Where did the seasonal flu go? ?

While the flu kills an average of 10,000 people the years, we hardly heard about it this year. In one previous post, I was wondering about a possible overestimation of the number deaths and cases of coronavirus. What if we had classified coronavirus a majority of people with the flu ?  This angry question will fuel many debates. As a matter of fact, we are currently unable to differentiate between deaths related to flu or coronavirus this year !

We would like to know how many people have died of the flu in total this winter! But this data is curiously absent… According to Public Health France (influenza surveillance bulletin published in March 2020, week 9), 72 people had died from the flu between November 2019 and the beginning of March 2020. It is not much because it only concerns intensive care cases. In his last newsletter (week 11), this figure rises to 88 death, still from intensive care units. And still no death toll from the flu ... But the agency reports that it is his ultimate flu watch report and that it now switch to specific surveillance of Covid-19 ...

As the newspaper rightly points out Release (article 4 March 2020), this influenza-related mortality data should be normally present, because this is the case with other monitoring bulletins from previous seasons. Why are cumulative influenza mortality data not being produced this year ? This is all the more disturbing as the agency should be able to produce these figures, as she does for the coronavirus now.

As a matter of fact, as you will see, it is the same criterion of acute respiratory infection (IRA) which will serve as a basis for determine the extent of the flu epidemic ... like the coronavirus. Determine the cause (influenza virus or coronavirus), is it left to appreciation of Public Health France? Has it been decided to classify the majority of IRAs from this winter in the coronavirus box?

These are crucial questions that deserve a real debate. But they are currently ignored by the mainstream media, busy giving us a daily count of the number of deaths in France attributed to the coronavirus epidemic. As I explain in my book Toxic Company, Manual of Mental pollution, about media intoxication, this is one of the major problems of our media : in the age of obesity, they are overwhelmed by the amount of information and no longer have the time to take a step back from the analysis to offer us quality content…

How do we monitor flu usually ?

In this newsletter of 4 March 2020 regarding seasonal flu, we can read "Since the week 40, For about 10 000 communities of elderly people identified in France, 531 clustered case episodes of acute respiratory infection (IRA) have been reported to Public Health France ”. Beyond the fact that this figure is extraordinarily low compared to previous years (see the table below), I especially draw your attention to the fact that acute respiratory infection (IRA) is apparently the same criterion used to report a possible case of influenza (See as well this document). As you will see below, this criterion is the main one for defining a probable case of coronavirus ...

Source : influenza surveillance bulletin published in March 2020

Why Public Health France does not give the number of deaths by influenza?

Asked by Release, the French Public Health agency explains, the 4 March 2020, that she cannot provide figures for excess flu-related mortality this year in the absence of general excess mortality in the population.  Yes, you read correctly, the 4 March 2020, there was no general excess mortality in the population according to the agency. "If there was an excess mortality during the season 2018-2019, there aren't any this winter at this point”, she explains to Release. This does not mean that there have not been deaths from the flu. (nor that there were only 72). Simply that as it is, Public Health France's calculation method does not allow this value to be calculated for the whole country - since this"Influenza-attributable mortality model is applied when excess mortality is found". She repeats the same argument in the last surveillance bulletin published on 18 March.

No excess mortality this year?

And the 20,000 deaths from the coronavirus? The winter mortality figures (that I detailed in a other post) clearly show a phenomenon of classic excess mortality during winter (even if this excess mortality is not "exceptional" for the moment).

Source : Insee

I also recommend reading an old one Figaro-Magazine article which shows this threshold from which Public Health France can determine excess mortality and therefore be able to determine the number of deaths from influenza.

We see well in this diagram that the threshold from which the excess is significant (line black) is relatively low. We don't understand why this year, the Health agency public service in France does not detect excess mortality even though there is still a peak winter mortality.

All the the work of epidemiological statistics of Public Health France is to arrive at set a number of flu-related deaths, without relying on certificates alone of deceased, which very often mention a pre-existing pathology:

"In older people affected by influenza, most deaths occur late in relation to influenza infection, either because bacteria take advantage of the patient's weakness to superinfect him, either following decompensations linked to a precarious general condition. Dans ce cas, flu is often not mentioned on the death certificate ", explained Daniel Lévy-Bruhl, epidemiologist at Public Health France, to the newspaper Le Figaro in this article from 8 March 2017.

But this year, Once is not custom, Public health France is unable to produce this figure ...

Much less consultations and hospitalizations related to influenza

The agency Public health France produces well, en revanche, Sentinel data concerning the number of consultations for flu syndrome this year. They are significantly lower than last year.

Source : influenza surveillance bulletin published in March 2020

Of even in the hospital. There are far fewer hospitalizations attributed to influenza.

Source : influenza surveillance bulletin published in March 2020

Of side of tests carried out in city medicine, on 2 099 samples analyzed, 1 003 were flu positive (48%). In a hospital environment, sur les 102 356 samples analyzed, 12 871 (12,6%) influenza viruses have been detected. Concretely, this means that cases attributed to influenza are not necessarily people who had the flu virus. They could as well be carrying another virus or a bacterial infection.

How do we monitor the coronavirus today?

Here is what the educational file dedicated to covid-19 from the Public Health France agency.  «A wild : consultations for acute respiratory infections are monitored (IRA) from the Sentinelles network and the daily and weekly number of patients consulting SOS-Médecins for suspected COVID-19 through home visits and in consultation centers. In seniors' communities, cases of acute respiratory infections (IRA) suspected of being linked to COVID-19 are reported to Regional Health Agencies (ARS). A l’hôpital, we count the visits to hospital emergencies for suspicion of COVID-19, hospitalizations related to COVID-19, serious cases hospitalized in intensive care ". The agency also explains that it relies on general mortality and surveillance of acute respiratory infections (IRA) in the general population, whether patients see a doctor or not.

AT reading this document, we realize that it is the respiratory infection acute which makes it possible to suspect a case of coronavirus (like the flu). But to determine a fairer proportion, the agency explains that it is also based on samples taken: 

Today, the Sentinels Network and Public Health France apply the same statistical method as that used to estimate the number of influenza patients seen in clinic visits city ​​medicine. The statistical method integrates two types of data : the number of possible cases of COVID-19 diagnosed by consultation or teleconsultation and the proportion of positive COVID-19 cases in the sample taken. As in any sampling method, this extrapolation gives a result which has a margin of uncertainty ".

To this first uncertainty is added that which hovers over a good number of cases reported outside the medical network of city. So, episodes reported by accommodation establishments for dependent elderly people (Ehpad) are defined by the occurrence of at least 1 case possible COVID-19 among residents or health professionals. No need for "Clustered cases" as with influenza, and no need for tests (so from case confirmed). Acute respiratory infection is enough. Data from SOS doctors are probably no more reliable: "The data transmitted make it possible to estimate the daily and weekly number of patients consultant for an ARI and therefore for suspicion of COVID-19 ".  

Flu or coronavirus : an effect of vases communicators?

In my opinion, the little hands that compile the figures for statistical agencies must be, at a time, to choose between two boxes: flu or coronavirus! Apparemment, the box flu is not popular this year… In particular in the data of EHPAD, who usually pay a heavy price for seasonal ailments like the flu.

The conclusion, is that we will have a hard time have clear numbers to sort out cases of influenza or coronavirus. Only overall mortality will allow to know if we really lived an epidemic episode justifying confinement.

If there is "no excess overall mortality", as Public Health France says to Release, how can she characterize another epidemic or even a coronavirus pandemic in the absence of this essential data ? It is very curious that the agency does not manage to produce flu death figures when she does perfectly to do it for the coronavirus. Is she really using the same method statistic or did she undress Paul to dress Peter??

Let's give the agency a few more weeks to try to provide us with a death figure attributed to influenza. But it's a safe bet that they will be far below usual levels ...

This article was published in the Pure Santé network, of the Health Nature Innovation group. To follow my next articles, you can join the network.

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A commentary on “Where did the seasonal flu go? ?”

  1. Excellent article. By correlating data like those from INSEE here on which I have also worked: https://www.insee.fr/fr/information/4470857?fbclid=IwAR2kbK7mS-ELM0Uw-w1n2T4lHM08ZRiI_yZYyHvWQKN0uMsi615RrG5MAtg

    …we quickly come to the conclusion that we are swimming in irrational delirium.

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